Intracardiac Echocardiography Guided electrified J-wire trans-septal puncture: a prospective randomized controlled trial

Abstract

Background: Application of electrocautery to a J-wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique. Methods: 200 consecutive patients were randomized in a 1:1 fashion to either the ICE-guided electrified J-wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20W, “coag” mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time. Results: All patients complete the procedure safely. The electrified J-wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra-atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the 2 groups (3/32 patients in the J-wire TSP group and 2/26 patients in conventional BRK TSP group, p=0.82). And no difference in the incidence of residual intra-atrial shunt (4.3% versus 6%, p=0.654) during the 3-month’s follow up. Conclusion: Using an electrified J-wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non-fluoroscopy AF ablation.

A PLC-based pomegranate sprout removal device design

“…Take the data into formula ( 8)~ (10). Since the control here is inching control, there is no Angular acceleration.…”

“…At present, manual pruning is mostly used [8,9] . Manual tillering is inefficient, costly and dangerous [10,11] .At present, there is no specific device to remove the sprouting of pomegranate trees. One of the main methods is manual tillering, which uses a knife, branch scissors or electric scissors to prune the sprouting from the trunk.…”

“…One of the main methods is manual tillering, which uses a knife, branch scissors or electric scissors to prune the sprouting from the trunk. This method can completely remove the sprouting without causing damage to the trunk of the tree, but it consumes a lot of time and is difficult to prune the pomegranate trees at high places [10] ; In addition, the branches of pomegranate are complex in structure, and the distribution angles and orientations of sprouting tillers are uneven. Branch scissors…”